Improving The Design and Permitting Process for Acute Care Facilities in California Developing a Future State Map For California Healthcare Projects June.

Improving The Design and Permitting Process for Acute Care Facilities in California

Improving The Design and Permitting Process for Acute Care Facilities in California

Developing a Future State Map For California Healthcare Projects

June 2007 Update

Developing a Future State Map For California Healthcare Projects

June 2007 Update

Challenges to Design of California Healthcare

Projects

Challenges to Design of California Healthcare

Projects Very Complex

Projects Three or More

Years From Design Start to Permit

OSHPD Review Changes in

Technology Limited Resources Large Batch

Process

Very Complex Projects

Three or More Years From Design Start to Permit

OSHPD Review Changes in

Technology Limited Resources Large Batch

Process

Ineffective Cost Control During Design

Poor Integration of Design and Construction Technology

Loss of Team Members

Poor Construction Phasing

Ineffective Cost Control During Design

Poor Integration of Design and Construction Technology

Loss of Team Members

Poor Construction Phasing

The Current StateThe Current State

Significant Construction Cost Overruns

Multiple Permit Re-submittalsPoor Drawing Quality and

Coordination Between DisciplinesLoss of Team ContinuityDesigners Losing MoneyOwners FrustratedOSHPD DefensiveContractors Avoiding

Significant Construction Cost Overruns

Multiple Permit Re-submittalsPoor Drawing Quality and

Coordination Between DisciplinesLoss of Team ContinuityDesigners Losing MoneyOwners FrustratedOSHPD DefensiveContractors Avoiding

Time for A ChangeTime for A Change

Industry Leaders Deciding To Create a Change in the Design Delivery Model

Boldt, Mazzetti, HGA, Herrero, Southland, Rutherford & Chekene, Rosendin

Application of Lean to Design ModelTried to Generate Current State VSMDetermined need for industry wide

visibility and participation

Industry Leaders Deciding To Create a Change in the Design Delivery Model

Boldt, Mazzetti, HGA, Herrero, Southland, Rutherford & Chekene, Rosendin

Application of Lean to Design ModelTried to Generate Current State VSMDetermined need for industry wide

visibility and participation

Value to CustomersValue to Customers

Healthcare Provider Meets Functional

Program Requirements

Meets Cost Goals Completed On-Time Built-In Quality Meets Life Cycle

Requirements Satisfies Community

Served

Healthcare Provider Meets Functional

Program Requirements

Meets Cost Goals Completed On-Time Built-In Quality Meets Life Cycle

Requirements Satisfies Community

Served

OSHPD Code Compliant Submitted On

Schedule Coordinated

Design Complete Easily Interpreted

Plans and Specifications

High Quality Accurate

OSHPD Code Compliant Submitted On

Schedule Coordinated

Design Complete Easily Interpreted

Plans and Specifications

High Quality Accurate

What Are We Trying To Achieve?

What Are We Trying To Achieve?

Meet Program Requirements

Level the Design and Construction Work Flow

Create More Accurate Submittal Packages

Integrate Cost with Design to Manage in Real Time

Create a Baseline Starting Point for the Design Process

Deliver Only What “the customer” needs

Meet Program Requirements

Level the Design and Construction Work Flow

Create More Accurate Submittal Packages

Integrate Cost with Design to Manage in Real Time

Create a Baseline Starting Point for the Design Process

Deliver Only What “the customer” needs

Keep the Design and Construction Team Integrated Throughout the Project Lifecycle

Shorten the Time to Market

Provide Flexibility Where Needed to Meet Program Requirements

Create a Process that Will Encourage Truly Collaborative Behavior When Used Together with Other Lean Tools and Methods

Keep the Design and Construction Team Integrated Throughout the Project Lifecycle

Shorten the Time to Market

Provide Flexibility Where Needed to Meet Program Requirements

Create a Process that Will Encourage Truly Collaborative Behavior When Used Together with Other Lean Tools and Methods

Progress To DateProgress To Date

Created Format for Five all day Workshops Sponsored By Industry and Hosted by UCB/P2SL Group

Invited the Community to ParticipateOwnersOSHPDArchitects/Engineers/DesignersGC/Specialty Contractors/VendorsEducation

Created Format for Five all day Workshops Sponsored By Industry and Hosted by UCB/P2SL Group

Invited the Community to ParticipateOwnersOSHPDArchitects/Engineers/DesignersGC/Specialty Contractors/VendorsEducation


Received Excellent Participation by Management from:OSHPD (5 People)CHW, St. Joseph's, UCSF Medical

Center, Kaiser, and Sutter HealthA&E CommunityCM/GC and Specialty Contractors

Between 60 and 88 participants throughout the 5 full day workshops.

Received Excellent Participation by Management from:OSHPD (5 People)CHW, St. Joseph's, UCSF Medical

Center, Kaiser, and Sutter HealthA&E CommunityCM/GC and Specialty Contractors

Between 60 and 88 participants throughout the 5 full day workshops.


Workshop One - Focus and Results Introduction of the Ideas and Intent of the

workshops. Hear from “Customers” what value is to

them and what they are doing to improve today.

OSHPD, CHW, Sutter, St. Joseph, Kaiser Break into four groups to map current state

of each of the four Owners. Cross functional teams pre-assigned. Developed Initial Current State Maps Team by Team report out of Progress and

Lessons Learned

Workshop One - Focus and Results Introduction of the Ideas and Intent of the

workshops. Hear from “Customers” what value is to

them and what they are doing to improve today.

OSHPD, CHW, Sutter, St. Joseph, Kaiser Break into four groups to map current state

of each of the four Owners. Cross functional teams pre-assigned. Developed Initial Current State Maps Team by Team report out of Progress and

Lessons Learned


Workshop Two - Focus and Results Discussion and Identification of 8 Wastes Completion of Current State Maps Identification of Opportunities For

Improvement based on Waste Identification During Current State Mapping Process

Completed Current State Maps Identified over 200 areas of waste in

existing process. Shared results with all teams

Workshop Two - Focus and Results Discussion and Identification of 8 Wastes Completion of Current State Maps Identification of Opportunities For

Improvement based on Waste Identification During Current State Mapping Process

Completed Current State Maps Identified over 200 areas of waste in

existing process. Shared results with all teams


Workshop Three - Focus and ResultsDiscussion and Identification Future

State Characteristics and Goals.Identification of Near Term (future

state) and Long Term (ideal state) opportunities.

Started work on both Future State and Ideal State Maps

Shared results with both teams

Workshop Three - Focus and ResultsDiscussion and Identification Future

State Characteristics and Goals.Identification of Near Term (future

state) and Long Term (ideal state) opportunities.

Started work on both Future State and Ideal State Maps

Shared results with both teams


Workshop Four - Focus and ResultsContinued work on both Future State

and Ideal State Maps and specific OFI areas.

Created a framework for continuing with this process upon completion of the five workshops.

Shared results with all teams

Workshop Four - Focus and ResultsContinued work on both Future State

and Ideal State Maps and specific OFI areas.

Created a framework for continuing with this process upon completion of the five workshops.



Workshop Five - Focus and ResultsIdentified Actual Pilot Projects that

will implement one or more process improvements from this workshop.

Reviewed the results of our waste priority survey.

Completed the framework for continuing with this process upon completion of the five workshops.


Workshop Five - Focus and ResultsIdentified Actual Pilot Projects that

will implement one or more process improvements from this workshop.

Reviewed the results of our waste priority survey.

Completed the framework for continuing with this process upon completion of the five workshops.


AccomplishmentsAccomplishments

Heard from our Customers what is important to them and where they believe opportunities for improvement exist in the industry and their own existing process. OSHPD, Sutter Health, Kaiser, CHW, and St Joseph’s.

Created a current state map of the design and permitting process for four major health care organizations.

Identified specific waste in each of those process maps, where there was resistance to changing the current process and additional areas where significant opportunities for improvement exist that need to be mapped in greater detail.

Identified goals and attributes of a future state map that would reduce much of the waste in the current state processes on our way to creating an ideal state.

Began the creation of several future state maps including both near term innovation and long term ideal state opportunities.

Identified Five Actual Pilot projects where new processes will be implemented to reduce waste and increase value to the customer.

Initiated the actual mapping of four of the five pilot projects.

Defined a framework for a committee under the guidance of P2SL to continue with the development, experimentation, and implementation of this future state process through the use of pilot projects, continuing education, project specific coaching, reporting and recording, design and tracking of metrics associated with each experiment, and organizing future workshops.

Heard from our Customers what is important to them and where they believe opportunities for improvement exist in the industry and their own existing process. OSHPD, Sutter Health, Kaiser, CHW, and St Joseph’s.

Created a current state map of the design and permitting process for four major health care organizations.

Identified specific waste in each of those process maps, where there was resistance to changing the current process and additional areas where significant opportunities for improvement exist that need to be mapped in greater detail.

Identified goals and attributes of a future state map that would reduce much of the waste in the current state processes on our way to creating an ideal state.

Began the creation of several future state maps including both near term innovation and long term ideal state opportunities.

Identified Five Actual Pilot projects where new processes will be implemented to reduce waste and increase value to the customer.

Initiated the actual mapping of four of the five pilot projects.

Defined a framework for a committee under the guidance of P2SL to continue with the development, experimentation, and implementation of this future state process through the use of pilot projects, continuing education, project specific coaching, reporting and recording, design and tracking of metrics associated with each experiment, and organizing future workshops.

BreakthroughsBreakthroughs

Realizing what can happen when all of the right people are in the room at the right time focused on the right thing with the right behavior.

Understanding and accepting our own roles and barriers to the elimination of waste.

Mapping is hard work but creates high value by helping the team focus on the real value added work.

Realizing what can happen when all of the right people are in the room at the right time focused on the right thing with the right behavior.

Understanding and accepting our own roles and barriers to the elimination of waste.

Mapping is hard work but creates high value by helping the team focus on the real value added work.

Images From Our Workshops




















Pilot Project UpdatePalo Alto Medical Foundation (PAMF)

Pilot Project UpdatePalo Alto Medical Foundation (PAMF)

Sutter’s Palo Alto Medical Foundation, San Carlos Center ProjectCurrent primary focus points

Integrated OSHPD reviewElimination of waste in production of

designTarget Value Design

Sutter’s Palo Alto Medical Foundation, San Carlos Center ProjectCurrent primary focus points

Integrated OSHPD reviewElimination of waste in production of

designTarget Value Design

OSHPD Process Palo Alto Medical Foundation (PAMF)


Reduce the design & permit cycle time.

Eliminate redesign Establish processes for acceptance. Identify the size of batches/packages

and to what disciplines. Establish clear and consistent

communication procedures. Interface protocol + Frequency Protocol for changes. Assigned staff stays on the job. What’s done is done.

Reduce the design & permit cycle time.

Eliminate redesign Establish processes for acceptance. Identify the size of batches/packages

and to what disciplines. Establish clear and consistent

communication procedures. Interface protocol + Frequency Protocol for changes. Assigned staff stays on the job. What’s done is done.



Developing a Standard Plan

Developing a Standard Plan

Three Sutter Teams Palo Alto Medical Center California Pacific Medical Center – CHH Sutter Elk Grove – Prototype #1

All Under IFOA Contract Creating Common Approach to

Design/Development/Permitting where possible

Presenting Standard Plan for OSHPD Engagement Consistent with IFOA and “Five Big Ideas” and Integrated Lean Project Delivery Process

Three Sutter Teams Palo Alto Medical Center California Pacific Medical Center – CHH Sutter Elk Grove – Prototype #1

All Under IFOA Contract Creating Common Approach to

Design/Development/Permitting where possible

Presenting Standard Plan for OSHPD Engagement Consistent with IFOA and “Five Big Ideas” and Integrated Lean Project Delivery Process

Draft of Sutter Proposed OSHPD Engagement PlanDraft of Sutter Proposed OSHPD Engagement Plan

Define team members with roles, responsibilities and authority (all members: OSHPD (field and office), S-FPD, SHA, Design and Construction Group, IOR,) Includes Org Chart Template that captures this information.

Define communication plan to include: Methods of communication (email, memos of understanding, drawings, digital models, Web X,

meetings, etc.) Channels for all communications. Identifying Batching of data. Expected response times for each type of communication. Regular meeting times if and when appropriate.

Create macro level proposed design, permit, construct, occupy, value stream map indicating approval packages.

Create Schedule to inform the development of rolling Six Week Look Ahead and Weekly Work Plans.

Identify workshops to have with team to address: Common language and lean principles. Delivery model. Design of the drawing and review process that makes the final review process for permit approval a

validation of previous decisions and agreements. Expectations of both sides Identify Specific deliverables by package (what does OSHPD need to see vs. what design group thinks

they want to see) Drawing and document model, packaging, content Define methodology to document agreements clearly Define methodology to clearly identify common design thread throughout approval packages as it

relates to code requirements Define failure response matrix to address breakdowns in the process so that we can learn and

respond to the inevitable (Plan Do Check Act loop) Define first run study to test the complete process with a small piece.

Identify how OSHPD can get paid for their involvement, per pending legislation (SB306). Train all members of the team (both sides)

Define team members with roles, responsibilities and authority (all members: OSHPD (field and office), S-FPD, SHA, Design and Construction Group, IOR,) Includes Org Chart Template that captures this information.

Define communication plan to include: Methods of communication (email, memos of understanding, drawings, digital models, Web X,

meetings, etc.) Channels for all communications. Identifying Batching of data. Expected response times for each type of communication. Regular meeting times if and when appropriate.

Create macro level proposed design, permit, construct, occupy, value stream map indicating approval packages.

Create Schedule to inform the development of rolling Six Week Look Ahead and Weekly Work Plans.

Identify workshops to have with team to address: Common language and lean principles. Delivery model. Design of the drawing and review process that makes the final review process for permit approval a

validation of previous decisions and agreements. Expectations of both sides Identify Specific deliverables by package (what does OSHPD need to see vs. what design group thinks

they want to see) Drawing and document model, packaging, content Define methodology to document agreements clearly Define methodology to clearly identify common design thread throughout approval packages as it

relates to code requirements Define failure response matrix to address breakdowns in the process so that we can learn and

respond to the inevitable (Plan Do Check Act loop) Define first run study to test the complete process with a small piece.

Identify how OSHPD can get paid for their involvement, per pending legislation (SB306). Train all members of the team (both sides)

Additional Challenges and Ongoing Work

Additional Challenges and Ongoing Work

Legal Boundaries for OSHPD (SB306) Creating Ideal/Future State Map Publishing a “Current Best Practice”

Document Presenting to Industry to Maintain

Momentum (AIA, CII, ASHE, Etc) Investigating Alternate Ideas to Aid or

Speed the Process OSHPD Review/Use of BIM/VDC models Use of technology vs. capital limitations

Celebrating and Promoting Successes to OSHPD and Industry

Legal Boundaries for OSHPD (SB306) Creating Ideal/Future State Map Publishing a “Current Best Practice”

Document Presenting to Industry to Maintain

Momentum (AIA, CII, ASHE, Etc) Investigating Alternate Ideas to Aid or

Speed the Process OSHPD Review/Use of BIM/VDC models Use of technology vs. capital limitations

Celebrating and Promoting Successes to OSHPD and Industry

Questions?Questions?

Suggestions? Input?Volunteers? Ideas?

Suggestions? Input?Volunteers? Ideas?

Improving The Design and Permitting Process for Acute Care Facilities in California Developing a Future State Map For California Healthcare Projects June.

Documents

design modeltried

design processdeliver

current state vsmdetermined

construction team

initial current state

design delivery modelboldt

future state map

day workshops